胆汁淤积性肝病患者的候补名单死亡率和移植后生存率 - 分配政策变化的影响。
Waitlist mortality and post-transplant survival in patients with cholestatic liver disease - Impact of changes in allocation policy.
机构信息
Department of Surgery, Division of Transplantation, Medical University of Vienna, Austria.
Department of Statistics and Operations Research, University of Vienna, Vienna, Austria.
出版信息
HPB (Oxford). 2018 Oct;20(10):916-924. doi: 10.1016/j.hpb.2018.03.013. Epub 2018 Jun 21.
BACKGROUND
This study investigated the impact of Model of end-stage liver disease (MELD)-score introduction (MELDi) on waitlist mortality and post-liver transplant (LT) survival in primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).
METHODS
LT candidates with PSC or PBC listed between January 1983 and March 2016 were included and followed until December 2016. After MELDi in 2004, PBC patients were listed according to labMELD, PSC patients according to the highest MELD during active cholangitis (chMELD).
RESULTS
In total, 100 PBC and 76 PSC patients were included. Waitlist mortality in PBC was significantly higher than in PSC (16% vs. 5.3%, p = 0.031), whereas PSC patients were significantly more often withdrawn from the waitlist due to improved condition (3.0% vs. 13.2%, p = 0.017). Competing risks analysis identified MELDi (HR = 4.12) and PBC (HR = 2.95) as significant predictors of waitlist mortality. Yet, overall 10 y-patient survival increased after MELDi by 18.8% leading to a 1 y-, 5 y-, and 10 y-patient survival of 98.2%, 70.6% and 70.6% in PBC, and 83.3%, 83.3%, and 80.6% in PSC, respectively.
CONCLUSIONS
PSC patients showed significantly lower waitlist mortality irrespective of MELDi, whereas in PBC waitlist mortality further increased after MELDi. Utility of MELD and chMELD did not impair post LT outcome.
背景
本研究旨在探讨终末期肝病模型（MELD）评分引入（MELDi）对原发性胆汁性胆管炎（PBC）和原发性硬化性胆管炎（PSC）患者等待肝移植（LT）期间死亡率和 LT 后生存率的影响。
方法
纳入 1983 年 1 月至 2016 年 3 月期间登记的 PSC 或 PBC 的 LT 候选者，并随访至 2016 年 12 月。2004 年 MELDi 引入后，PBC 患者按 labMELD 进行登记，PSC 患者按活动期胆管炎时的最高 MELD（chMELD）进行登记。
结果
共纳入 100 例 PBC 和 76 例 PSC 患者。PBC 患者的等待期死亡率显著高于 PSC 患者（16% vs. 5.3%，p=0.031），但 PSC 患者因病情改善而退出等待名单的比例明显更高（3.0% vs. 13.2%，p=0.017）。竞争风险分析表明，MELDi（HR=4.12）和 PBC（HR=2.95）是等待期死亡率的显著预测因素。然而，MELDi 引入后，总体 10 年患者生存率提高了 18.8%，导致 PBC 的 1 年、5 年和 10 年生存率分别为 98.2%、70.6%和 70.6%，PSC 的 1 年、5 年和 10 年生存率分别为 83.3%、83.3%和 80.6%。
结论
PSC 患者的等待期死亡率无论是否引入 MELDi 均显著降低，而 PBC 患者的等待期死亡率在引入 MELDi 后进一步增加。MELD 和 chMELD 的应用并未影响 LT 后的预后。
Zotero 插件